Havelock Ellis Sexual impulse in youth What was his view on sexual impulse in the youth? book, he goes into vivid detail of how children can experience sexuality differently in terms of time and intensity. How does he feel they experience it differently? sex impulse has no normal existence in early life, then every manifestation of it at that period must be 'perverse, Does he think that the youth are more sexually active than older people? He claims that the ability of some infants producing genital reactions, seen as "reflex signs of irritation" are typically not vividly remembered. Why did he come to this conclusion? However, Ellis claims that many people of both sexes can recall having agreeable sensations with the genitalia as a child. Were the recalling of sensations more in females or males? These authors provide cases for children of both sexes who have masturbated from the age of three or four. Who were the other authors? I don't know.
Did he have any thoughts on the hereditary of sexual excitement?
Did Havelock Ellis have any thoughts on the hereditary of sexual excitement?
Dr. Havelock Ellis' 1933 book, Psychology of Sex, is one of the many manifestations of his interest in human sexuality. In this book, he goes into vivid detail of how children can experience sexuality differently in terms of time and intensity. He mentions that it was previously believed that, in childhood, humans had no sex impulse at all. "If it is possible to maintain that the sex impulse has no normal existence in early life, then every manifestation of it at that period must be 'perverse,'" he adds. He continues by stating that, even in the early development and lower function levels of the genitalia, there is a wide range of variation in terms of sexual stimulation. He claims that the ability of some infants producing genital reactions, seen as "reflex signs of irritation" are typically not vividly remembered. Since the details of these manifestations are not remembered, there is no possible way to determine them as pleasurable. However, Ellis claims that many people of both sexes can recall having agreeable sensations with the genitalia as a child. "They are not (as is sometimes imagined) repressed." They are, however, not usually mentioned to adults. Ellis argues that they typically stand out and are remembered for the sole contrast of the intense encounter to any other ordinary experience.  Ellis claims that sexual self-excitement is known to happen at an early age. He references authors like Marc, Fonssagrives, and Perez in France who published their findings in the nineteenth century. These early ages are not strictly limited to ages close to puberty as can be seen in their findings. These authors provide cases for children of both sexes who have masturbated from the age of three or four. Ellis references Robie's findings that boys' first sex feelings appear between the ages of five and fourteen. For girls, this age ranges from eight to nineteen. For both sexes, these first sexual experiences arise more frequently during the later years as opposed to the earlier years. Ellis then references Hamilton's studies that found twenty percent of males and fourteen percent of females have pleasurable experiences with their sex organs before the age of six. This is only supplemented by Ellis' reference to Katharine Davis' studies, which found that twenty to twenty-nine percent of boys and forty-nine to fifty-one percent were masturbating by the age of eleven. However, in the next three years after, boys' percentages exceeded that of girls.  Dr. Ellis also contributed to the idea of varying levels of sexual excitation. He asserts it is a mistake to assume all children experience are able to experience genital arousal or pleasurable erotic sensations. He proposes cases where an innocent child is led to believe that stimulation of the genitalia will result in a pleasurable erection. Some of these children may fail and not be able to experience this either pleasure or an erection until puberty. Ellis concludes, then, that children are capable of a "wide range of genital and sexual aptitude." Ellis even considers ancestry as contributions to different sexual excitation levels, stating that children of "more unsound heredity" and/or hypersexual parents are "more precociously excitable." CANNOTANSWER
Ellis argues that they typically stand out and are remembered for the sole contrast of the intense encounter to any other ordinary experience.
Henry Havelock Ellis (2 February 1859 – 8 July 1939) was an English physician, eugenicist, writer, progressive intellectual and social reformer who studied human sexuality. He co-wrote the first medical textbook in English on homosexuality in 1897, and also published works on a variety of sexual practices and inclinations, as well as on transgender psychology. He is credited with introducing the notions of narcissism and autoeroticism, later adopted by psychoanalysis.

Ellis was among the pioneering investigators of psychedelic drugs and the author of one of the first written reports to the public about an experience with mescaline, which he conducted on himself in 1896. He supported eugenics and served as one of 16 vice-presidents of the Eugenics Society from 1909 to 1912.

Early life and career
Ellis, son of Edward Peppen Ellis and Susannah Mary Wheatley, was born in Croydon, Surrey (now part of Greater London). He had four sisters, none of whom married. His father was a sea captain, his mother the daughter of a sea captain, and many other relatives lived on or near the sea. When he was seven his father took him on one of his voyages, during which they called at Sydney, Australia; Callao, Peru; and Antwerp, Belgium. After his return, Ellis attended the French and German College near Wimbledon, and afterward attended a school in Mitcham.

In April 1875, Ellis sailed on his father's ship for Australia; soon after his arrival in Sydney, he obtained a position as a master at a private school. After the discovery of his lack of training, he was fired and became a tutor for a family living a few miles from Carcoar, New South Wales. He spent a year there and then obtained a position as a master at a grammar school in Grafton, New South Wales. The headmaster had died and Ellis carried on at the school for that year, but was unsuccessful.

At the end of the year, he returned to Sydney and, after three months' training, was given charge of two government part-time elementary schools, one at Sparkes Creek, near Scone, New South Wales, and the other at Junction Creek. He lived at the school house on Sparkes Creek for a year. He wrote in his autobiography, "In Australia, I gained health of body, I attained peace of soul, my life task was revealed to me, I was able to decide on a professional vocation, I became an artist in literature; these five points covered the whole activity of my life in the world. Some of them I should doubtless have reached without the aid of the Australian environment, scarcely all, and most of them I could never have achieved so completely if chance had not cast me into the solitude of the Liverpool Range."

Medicine and psychology
Ellis returned to England in April 1879. He had decided to take up the study of sex and felt his first step must be to qualify as a physician. He studied at St Thomas's Hospital Medical School, now part of King's College London, but never had a regular medical practice. His training was aided by a small legacy and also income earned from editing works in the Mermaid Series of lesser known Elizabethan and Jacobean drama. He joined The Fellowship of the New Life in 1883, meeting other social reformers Eleanor Marx, Edward Carpenter and George Bernard Shaw.

The 1897 English translation of Ellis's book Sexual Inversion, co-authored with John Addington Symonds and originally published in German in 1896, was the first English medical textbook on homosexuality. It describes male homosexual relations as well as adolescent rape. Ellis wrote the first objective study of homosexuality, as he did not characterise it as a disease, immoral, or a crime. The work assumes that same-sex love transcended age taboos as well as gender taboos. The first edition of the book was bought-out by the executor of Symond's estate, who forbade any mention of Symonds in the second edition.

In 1897 a bookseller was prosecuted for stocking Ellis's book. Although the term homosexual is attributed to Ellis, he wrote in 1897, "'Homosexual' is a barbarously hybrid word, and I claim no responsibility for it." In fact, the word homosexual was coined in 1868 by the Hungarian author Karl-Maria Kertbeny.

Ellis may have developed psychological concepts of autoerotism and narcissism, both of which were later developed further by Sigmund Freud. Ellis's influence may have reached Radclyffe Hall, who would have been about 17 years old at the time Sexual Inversion was published. She later referred to herself as a sexual invert and wrote of female "sexual inverts" in Miss Ogilvy Finds Herself and The Well of Loneliness. When Ellis bowed out as the star witness in the trial of  The Well of Loneliness on 14 May 1928, Norman Haire was set to replace him but no witnesses were called.

Eonism
Ellis studied what today are called transgender phenomena. Together with Magnus Hirschfeld, Havelock Ellis is considered a major figure in the history of sexology to establish a new category that was separate and distinct from homosexuality. Aware of Hirschfeld's studies of transvestism, but disagreeing with his terminology, in 1913 Ellis proposed the term sexo-aesthetic inversion to describe the phenomenon. In 1920 he coined the term eonism, which he derived from the name of a historical figure, the Chevalier d'Éon. Ellis explained:

Ellis found eonism to be "a remarkably common anomaly", and "next in frequency to homosexuality among sexual deviations", and categorized it as "among the transitional or intermediate forms of sexuality". As in the Freudian tradition, Ellis postulated that a "too close attachment to the mother" may encourage eonism, but also considered that it "probably invokes some defective endocrine balance".

Marriage 

In November 1891, at the age of 32, and reportedly still a virgin, Ellis married the English writer and proponent of women's rights Edith Lees. From the beginning, their marriage was unconventional, as Edith Lees was openly lesbian. At the end of the honeymoon, Ellis went back to his bachelor rooms in Paddington. She lived at Fellowship House. Their "open marriage" was the central subject in Ellis's autobiography, My Life. Ellis reportedly had an affair with Margaret Sanger.

According to Ellis in My Life, his friends were much amused at his being considered an expert on sex. Some knew that he reportedly suffered from impotence until the age of 60. He then discovered that he could become aroused by the sight of a woman urinating. Ellis named this "undinism". After his wife died, Ellis formed a relationship with a French woman, Françoise Lafitte.

Eugenics
Ellis was a supporter of eugenics. He served as vice-president to the Eugenics Education Society and wrote on the subject, among others, in The Task of Social Hygiene:

In his early writings, it was clear that Ellis concurred with the notion that there was a system of racial hierarchies, and that non-western cultures were considered to be "lower races". Before explicitly talking about eugenic topics, he used the prevalence of homosexuality in these 'lower races' to indicate the universality of the behavior. In his work, Sexual Inversions, where Ellis presented numerous cases of homosexuality in Britain, he was always careful to mention the race of the subject and the health of the person's 'stock', which included their neuropathic conditions and the health of their parents. However, Ellis was clear to assert that he did not feel that homosexuality was an issue that eugenics needed to actively deal with, as he felt that once the practice was accepted in society, those with homosexual tendencies would comfortably choose not to marry, and thus would cease to pass the 'homosexual heredity' along.

In a debate in the Sociological Society, Ellis corresponded with noted eugenicist Francis Galton, who was presenting a paper in support of marriage restrictions. While Galton analogized eugenics to breeding domesticated animals, Ellis felt that a greater sense of caution was needed before applying the eugenic regulations to populations, as "we have scarcely yet realized how subtle and far-reaching hereditary influences are." Instead, because unlike domesticated animals, humans were in charge of who they mated with, Ellis argued that a greater emphasis was needed on public education about how vital this issue was. Ellis thus held much more moderate views than many contemporary eugenicists. In fact, Ellis also fundamentally disagreed with Galton's leading ideas that procreation restrictions were the same as marriage restrictions. Ellis believed that those who should not procreate should still be able to gain all the other benefits of marriage, and to not allow that was an intolerable burden. This, in his mind, was what led to eugenics being "misunderstood, ridiculed, and regarded as a fad".

Throughout his life, Ellis was both a member and later a council member of the Eugenics Society. Moreover, he played a role on the General Committee of the First International Eugenics Congress.

Sexual impulse in youth 
Ellis' 1933 book, Psychology of Sex, is one of the many manifestations of his interest in human sexuality. In this book, he goes into vivid detail of how children can experience sexuality differently in terms of time and intensity. He mentions that it was previously believed that, in childhood, humans had no sex impulse at all. "If it is possible to maintain that the sex impulse has no normal existence in early life, then every manifestation of it at that period must be 'perverse, he adds. He continues by stating that, even in the early development and lower function levels of the genitalia, there is a wide range of variation in terms of sexual stimulation. He claims that the ability of some infants producing genital reactions, seen as "reflex signs of irritation" are typically not vividly remembered. Since the details of these manifestations are not remembered, there is no possible way to determine them as pleasurable. However, Ellis claims that many people of both sexes can recall having agreeable sensations with the genitalia as a child. "They are not (as is sometimes imagined) repressed." They are, however, not usually mentioned to adults. Ellis argues that they typically stand out and are remembered for the sole contrast of the intense encounter to any other ordinary experience.

Ellis claims that sexual self-excitement is known to happen at an early age. He references authors like Marc, Fonssagrives, and Perez in France who published their findings in the nineteenth century. These early ages are not strictly limited to ages close to puberty as can be seen in their findings. These authors provide cases for children of both sexes who have masturbated from the age of three or four. Ellis references Robie's findings that boys' first sex feelings appear between the ages of five and fourteen. For girls, this age ranges from eight to nineteen. For both sexes, these first sexual experiences arise more frequently during the later years as opposed to the earlier years. Ellis then references G.V. Hamilton's studies that found twenty percent of males and fourteen percent of females have pleasurable experiences with their sex organs before the age of six. This is only supplemented by Ellis' reference to Katharine Davis' studies, which found that twenty to twenty-nine percent of boys and forty-nine to fifty-one percent of girls were masturbating by the age of eleven. However, in the next three years after, boys' percentages exceeded those of girls.

Ellis also contributed to the idea of varying levels of sexual excitation. He asserts it is a mistake to assume all children are able to experience genital arousal or pleasurable erotic sensations. He proposes cases where an innocent child is led to believe that stimulation of the genitalia will result in a pleasurable erection. Some of these children may fail and not be able to experience this either pleasure or an erection until puberty. Ellis concludes, then, that children are capable of a "wide range of genital and sexual aptitude". Ellis even considers ancestry as contributions to different sexual excitation levels, stating that children of "more unsound heredity" and/or hypersexual parents are "more precociously excitable".

Auto-eroticism 
Ellis' views of auto-eroticism were very comprehensive, including much more than masturbation. Auto-eroticism, according to Ellis, includes a wide range of phenomena. Ellis states in his 1897 book Studies in the Psychology of Sex, that auto-eroticism ranges from erotic day-dreams, marked by a passivity shown by the subject, to "unshamed efforts at sexual self-manipulation witnessed among the insane".

Ellis also argues that auto-erotic impulses can be heightened by bodily processes like menstrual flow. During this time, he says, women, who would otherwise not feel a strong propensity for auto-eroticism, increase their masturbation patterns. This trend is absent, however, in women without a conscious acceptance of their sexual feelings and in a small percentage of women suffering from a sexual or general ailment which result in a significant amount of "sexual anesthesia".

Ellis also raises social concern over how auto-erotic tendencies affect marriages. He goes on to tying auto-eroticism to declining marriage rates. As these rates decline, he concludes that auto-eroticism will only increase in both amount and intensity for both men and women. Therefore, he states, this is an important issue to both the moralist and physician to investigate psychological underpinnings of these experiences and determine an attitude toward them.

Smell 
Ellis believed that the sense of smell, although ineffective at long ranges, still contributes to sexual attraction, and therefore, to mate selection. In his 1905 book, Sexual selection in man, Ellis makes a claim for the sense of smell in the role of sexual selection. He asserts that while we have evolved out of a great necessity for the sense of smell, we still rely on our sense of smell with sexual selection. The contributions that smell makes in sexual attraction can even be heightened with certain climates. Ellis states that with warmer climates come a heightened sensitivity to sexual and other positive feelings of smell among normal populations. Because of this, he believes people are often delighted by odors in the East, particularly in India, in "Hebrew and Mohammedan lands". Ellis then continues by describing the distinct odours in various races, noting that the Japanese race has the least intense of bodily odours. Ellis concludes his argument by stating, "On the whole, it may be said that in the usual life of man odours play a not inconsiderable part and raise problems which are not without interest, but that their demonstrable part in actual sexual selection is comparatively small."

Views on women and birth control
Ellis favoured feminism from a eugenic perspective, feeling that the enhanced social, economic, and sexual choices that feminism provided for women would result in women choosing partners who were more eugenically sound. In his view, intelligent women would not choose, nor be forced to marry and procreate with feeble-minded men.

Ellis viewed birth control as merely the continuation of an evolutionary progression, noting that natural progress has always consisted of increasing impediments to reproduction, which lead to a lower quantity of offspring, but a much higher quality of them. From a eugenic perspective, birth control was an invaluable instrument for the elevation of the race. However, Ellis noted that birth control could not be used randomly in a way that could have a detrimental impact by reducing conception, but rather needed to be used in a targeted manner to improve the qualities of certain 'stocks'. He observed that it was unfortunately the 'superior stocks' who had knowledge of and used birth control while the 'inferior stocks' propagated without checks. Ellis' solution to this was a focus on contraceptives in education, as this would disseminate the knowledge in the populations that he felt needed them the most. Ellis argued that birth control was the only available way of making eugenic selection practicable, as the only other option was wide-scale abstention from intercourse for those who were 'unfit'.

Views on sterilization
Ellis was strongly opposed to the idea of castration for eugenic purposes. In 1909, regulations were introduced at the Cantonal Asylum in Bern, which allowed those deemed 'unfit' and with strong sexual inclinations to be mandatorily sterilized. In a particular instance, several men and women, including epileptics and paedophiles, were castrated, some of whom voluntarily requested it. While the results were positive, in that none of the subjects were found guilty of any more sexual offences, Ellis remained staunchly opposed to the practice. His view on the origin of these inclinations was that sexual impulses do not reside in the sexual organs, but rather they persist in the brain. Moreover, he posited that the sexual glands provided an important source of internal secretions vital for the functioning of the organism, and thus their removal could greatly injure the patient.

However, already in his time, Ellis was witness to the rise of vasectomies and ligatures of the Fallopian tubes, which performed the same sterilization without removing the whole organ. In these cases, Ellis was much more favourable, yet still maintaining that "sterilization of the unfit, if it is to be a practical and humane measure commanding general approval, must be voluntary on the part of the person undergoing it, and never compulsory." His opposition to such a system was not only rooted in morality. Rather, Ellis also considered the practicality of the situation, hypothesizing that if an already mentally unfit man is forced to undergo sterilization, he would only become more ill-balanced, and would end up committing more anti-social acts.

Though Ellis was never at ease with the idea of forced sterilizations, he was willing to find ways to circumvent that restriction. His focus was on the social ends of eugenics, and as a means to it, Ellis was in no way against 'persuading' 'volunteers' to undergo sterilization by withdrawing Poor Relief from them. While he preferred to convince those he deemed unfit using education, Ellis supported coercion as a tool. Furthermore, he supported adding ideas about eugenics and birth control to the education system in order to restructure society, and to promote social hygiene. For Ellis, sterilization seemed to be the only eugenic instrument that could be used on the mentally unfit. In fact, in his publication The Sterilization of the Unfit, Ellis argued that even institutionalization could not guarantee the complete prevention of procreation between the unfit, and thus, "the burdens of society, to say nothing of the race, are being multiplied. It is not possible to view sterilization with enthusiasm when applied to any class of people…but what, I ask myself, is the practical alternative?"

Psychedelics
Ellis was among the pioneering investigators of psychedelic drugs and the author of one of the first written reports to the public about an experience with mescaline, which he conducted on himself in 1896. He consumed a brew made of 3 Echinocacti (peyote) in the afternoon of Good Friday alone in his apartment in Temple, London. During the experience, lasting for about 24 hours, he noted a plethora of extremely vivid, complex, colourful, pleasantly smelling hallucinations, consisting both of abstract geometrical patterns and definite objects such as butterflies and other insects. He published the account of the experience in The Contemporary Review in 1898 (Mescal: A New Artificial Paradise). The title of the article alludes to an earlier work on the effects of mind-altering substances, an 1860 book Les Paradis artificiels by French poet Charles Baudelaire (containing descriptions of experiments with opium and hashish).

Ellis was so impressed with the aesthetic quality of the experience that he gave some specimens of peyote to the Irish poet W. B. Yeats, a member of the Hermetic Order of the Golden Dawn, an organisation of which another mescaline researcher, Aleister Crowley, was also a member.

Later life and death
Ellis resigned from his position of Fellow of the Eugenics Society over their stance on sterilization in January 1931.

Ellis spent the last year of his life at Hintlesham, Suffolk, where he died in July 1939. He is buried in Golders Green Crematorium, in North London.

Works

 The Criminal (1890)
 The New Spirit (1890)
 The Nationalisation of Health (1892)
 Man and Woman: A Study of Secondary and Tertiary Sexual Characteristics (1894) (revised 1929)
 translator: Germinal (by Zola) (1895) (reissued 1933)
  with J.A. Symonds
 Studies in the Psychology of Sex (1897–1928) six volumes (listed below)
 
 Affirmations (1898)
 
 The Nineteenth Century (1900)
 
 
 A Study of British Genius (1904)
 
 
 The Soul of Spain (1908)
 
 
 The Problem of Race-Regeneration (1911)
 The World of Dreams (1911) (new edition 1926)
 
 
 The Task of Social Hygiene (1912)
 
 The Philosophy of Conflict (1919)
 On Life and Sex: Essays of Love and Virtue (1921)
 
 Little Essays of Love and Virtue (1922)
 
 
 Sonnets, with Folk Songs from the Spanish (1925)
 Eonism and Other Supplementary Studies (1928)
 Studies in the Psychology of Sex Vol. 7 (1928)
 The Art of Life (1929) (selected and arranged by Mrs. S. Herbert)
 More Essays of Love and Virtue (1931)
 ed.: James Hinton: Life in Nature (1931)
 
 
 ed.: Imaginary Conversations and Poems: A Selection, by Walter Savage Landor (1933)
 Chapman (1934)
 My Confessional (1934)
 Questions of Our Day (1934)
 From Rousseau to Proust (1935)
 Selected Essays (1936)
 Poems (1937) (selected by John Gawsworth; pseudonym of T. Fytton Armstrong)
 Love and Marriage (1938) (with others)
 
 Sex Compatibility in Marriage (1939)
 From Marlowe to Shaw (1950) (ed. by J. Gawsworth)
 The Genius of Europe (1950)
 Sex and Marriage (1951) (ed. by J. Gawsworth)
 The Unpublished Letters of Havelock Ellis to Joseph Ishill (1954)

References

Bibliography

Further reading

 
 
   (U.S. title)

External links

 Havelock Ellis papers (MS 195). Manuscripts and Archives, Yale University Library 

 
 Henry Havelock Ellis papers from the Historic Psychiatry Collection, Menninger Archives, Kansas Historical Society
 
 
 

1859 births
1939 deaths
19th-century English non-fiction writers
20th-century English non-fiction writers
Alumni of King's College London
Alumni of St Thomas's Hospital Medical School
British sexologists
English eugenicists
English psychologists
People from Croydon
Psychedelic drug advocates
British relationships and sexuality writers
Medical writers on LGBT topics
British social reformers
Transgender studies academics
Victorian writers
Translators of Émile Zola
An intrusive thought is an unwelcome, involuntary thought, image, or unpleasant idea that may become an obsession, is upsetting or distressing, and can feel difficult to manage or eliminate. When such thoughts are associated with obsessive-compulsive disorder (OCD), depression, body dysmorphic disorder (BDD), and sometimes attention-deficit hyperactivity disorder (ADHD), the thoughts may become paralyzing, anxiety-provoking, or persistent. Intrusive thoughts may also be associated with episodic memory, unwanted worries or memories from OCD, post-traumatic stress disorder, other anxiety disorders, eating disorders, or psychosis. Intrusive thoughts, urges, and images are of inappropriate things at inappropriate times, and generally have aggressive, sexual, or blasphemous themes.

Description

General
Many people experience the type of bad or unwanted thoughts that people with more troubling intrusive thoughts have, but most people can dismiss these thoughts.  For most people, intrusive thoughts are a "fleeting annoyance". Psychologist Stanley Rachman presented a questionnaire to healthy college students and found that virtually all said they had these thoughts from time to time, including thoughts of sexual violence, sexual punishment, "unnatural" sex acts, painful sexual practices, blasphemous or obscene images, thoughts of harming elderly people or someone close to them, violence against animals or towards children, and impulsive or abusive outbursts or utterances.  Such thoughts are universal among humans, and have "almost certainly always been a part of the human condition".

When intrusive thoughts occur with obsessive-compulsive disorder (OCD), patients are less able to ignore the unpleasant thoughts and may pay undue attention to them, causing the thoughts to become more frequent and distressing.  The suppression of intrusive thoughts often cause these thoughts to become more intense and persistent. The thoughts may become obsessions that are paralyzing, severe, and constantly present, these might involve topics such as violence, sex, or religious blasphemy, among others.  Distinguishing them from normal intrusive thoughts experienced by many people, the intrusive thoughts associated with OCD may be anxiety provoking, irrepressible, and persistent.

How people react to intrusive thoughts may determine whether these thoughts will become severe, turn into obsessions, or require treatment.  Intrusive thoughts can occur with or without compulsions. Carrying out the compulsion reduces the anxiety, but makes the urge to perform the compulsion stronger each time it recurs, reinforcing the intrusive thoughts.  According to Lee Baer, suppressing the thoughts only makes them stronger, and recognizing that bad thoughts do not signify that one is truly evil is one of the steps to overcoming them.  There is evidence of the benefit of acceptance as an alternative to the suppression of intrusive thoughts. In one particular study, those instructed to suppress intrusive thoughts experienced more distress after suppression, while patients instructed to accept the bad thoughts experienced decreased discomfort.  These results may be related to underlying cognitive processes involved in OCD.  However, accepting the thoughts can be more difficult for persons with OCD.

The possibility that most patients suffering from intrusive thoughts will ever act on those thoughts is low. Patients who are experiencing intense guilt, anxiety, shame, and are upset over these thoughts are very different from those who actually act on them. The history of violent crime is dominated by those who feel no guilt or remorse; the very fact that someone is tormented by intrusive thoughts and has never acted on them before is an excellent predictor that they will not act upon the thoughts. Patients who are not troubled or shamed by their thoughts, do not find them distasteful, or who have actually taken action, might need to have more serious conditions such as psychosis or potentially criminal behaviors ruled out. According to Lee Baer, a patient should be concerned that intrusive thoughts are dangerous if the person does not feel upset by the thoughts, or rather finds them pleasurable; has ever acted on violent or sexual thoughts or urges; hears voices or sees things that others do not see; or feels uncontrollable irresistible anger.

Aggressive thoughts
Intrusive thoughts may involve violent obsessions about hurting others or themselves. They can be related to primarily obsessional obsessive compulsive disorder. These thoughts can include harming a child; jumping from a bridge, mountain, or the top of a tall building; urges to jump in front of a train or automobile; and urges to push another in front of a train or automobile.  Rachman's survey of healthy college students found that virtually all of them had intrusive thoughts from time to time, including:
 causing harm to elderly people
 imagining or wishing harm upon someone close to oneself
 impulses to violently attack, hit, harm or kill a person, small child, or animal
 impulses to shout at or abuse someone, or attack and violently punish someone, or say something rude, inappropriate, nasty, or violent to someone.

These thoughts are part of being human, and need not ruin the quality of life.  Treatment is available when the thoughts are associated with OCD and become persistent, severe, or distressing.

A variant of aggressive intrusive thoughts is L'appel du vide, or the call of the void. Sufferers of L'appel du vide generally describe the condition as manifesting in certain situations, normally as a wish or brief desire to jump from a high location.

Sexual thoughts
Sexual obsession involves intrusive thoughts or images of "kissing, touching, fondling, oral sex, anal sex, intercourse, and rape" with "strangers, acquaintances, parents, children, family members, friends, coworkers, animals and religious figures", involving "heterosexual or homosexual content" with persons of any age.

Common sexual themes for intrusive thoughts for men involve “(a) having sex in a public place, (b) people I come in contact with being naked, and (c) engaging in a sexual act with someone who is unacceptable to me because they have authority over me.” While common sexual intrusive thoughts for women are (a) having sex in a public place, (b) engaging in a sexual act with someone who is unacceptable to me because they have authority over me, and (c) being sexually victimized.

Like other unwanted intrusive thoughts or images, most people have some inappropriate sexual thoughts at times, but people with OCD may attach significance to the unwanted sexual thoughts, generating anxiety and distress.  The doubt that accompanies OCD leads to uncertainty regarding whether one might act on the intrusive thoughts, resulting in self-criticism or loathing.

One of the more common sexual intrusive thoughts occurs when an obsessive person doubts their sexual identity.  As in the case of most sexual obsessions, sufferers may feel shame and live in isolation, finding it hard to discuss their fears, doubts, and concerns about their sexual identity.

A person experiencing sexual intrusive thoughts may feel shame, "embarrassment, guilt, distress, torment, fear of acting on the thought or perceived impulse, and doubt about whether they have already acted in such a way."  Depression may be a result of the self-loathing that can occur, depending on how much the OCD interferes with daily functioning or causes distress.  Their concern over these thoughts may cause them to scrutinize their bodies to determine if the thoughts result in feelings of arousal.  However, focusing their attention on any part of the body can result in feelings in that body part, hence doing so may decrease confidence and increase fear about acting on the urges.  Part of the treatment of sexual intrusive thoughts involves therapy to help sufferers accept intrusive thoughts and stop trying to reassure themselves by checking their bodies. This arousal within the body parts is due to conditioned physiological responses in the brain, which do not respond to the subject of the sexual intrusive thought but rather to the fact that a sexual thought is occurring at all and thus engage an automatic response (research indicates that the correlation between what the genitalia regard as "sexually relevant" and what the brain regards as "sexually appealing" only correlates 50% of the time in men and 10% of the time in women). This means that an arousal response does not necessarily indicate that the person desires what they are thinking about. However, rational thinking processes attempt to explain this reaction and OCD causes people to attribute false meaning and importance to these physiological reactions in an attempt to make sense of them. Sufferers can also experience heightened anxiety caused by "forbidden" images or simply by discussing the matter which can then also cause physiological arousal, such as sweating, increased heart rate and some degree of tumescence or lubrication. This is often misinterpreted by the sufferer as an indication of desire or intent, when it is in fact not.

Religious thoughts

Blasphemous thoughts are a common component of OCD, documented throughout history; notable religious figures such as Martin Luther and Ignatius of Loyola were known to be tormented by intrusive, blasphemous or religious thoughts and urges. Martin Luther had urges to curse God and Jesus, and was obsessed with images of "the Devil's behind."  St. Ignatius had numerous obsessions, including the fear of stepping on pieces of straw forming a cross, fearing that it showed disrespect to Christ.  A study of 50 patients with a primary diagnosis of obsessive-compulsive disorder found that 40% had religious and blasphemous thoughts and doubts—a higher, but not statistically significantly different number than the 38% who had the obsessional thoughts related to dirt and contamination more commonly associated with OCD.  One study suggests that the content of intrusive thoughts may vary depending on culture, and that blasphemous thoughts may be more common in men than in women.

According to Fred Penzel, a New York psychologist, some common religious obsessions and intrusive thoughts are:
 sexual thoughts about God, saints, and religious figures
 bad thoughts or images during prayer or meditation
 thoughts of being possessed
 fears of sinning or breaking a religious law or performing a ritual incorrectly
 fears of omitting prayers or reciting them incorrectly
 repetitive and intrusive blasphemous thoughts
 urges or impulses to say blasphemous words or commit blasphemous acts during religious services.

Suffering can be greater and treatment complicated when intrusive thoughts involve religious implications; patients may believe the thoughts are inspired by Satan, and may fear  punishment from God or have magnified shame because they perceive themselves as sinful.  Symptoms can be more distressing for sufferers with strong religious convictions or beliefs.

Baer believes that blasphemous thoughts are more common in Catholics and evangelical Protestants than in other religions, whereas Jews or Muslims tend to have obsessions related more to complying with the laws and rituals of their faith, and performing the rituals perfectly.  He hypothesizes that this is because what is considered inappropriate varies among cultures and religions, and intrusive thoughts torment their sufferers with whatever is considered most inappropriate in the surrounding culture.

Age factors 
Adults under the age of 40 seem to be the most affected by intrusive thoughts. Individuals in this age range tend to be less experienced at coping with these thoughts, and the stress and negative affect induced by them. Younger adults also tend to have stressors specific to that period of life that can be particularly challenging especially in the face of intrusive thoughts. Although, when introduced with an intrusive thought, both age groups immediately look for ways to reduce the recurrence of the thoughts.

Those in middle adulthood (40-60) have the highest prevalence of OCD and therefore seem to be the most susceptible to the anxiety and negative emotions associated with intrusive thought. Middle adults are in a unique position because they have to struggle with both the stressors of early and late adulthood. They may be more vulnerable to intrusive thought because they have more topics to relate to. Even with this being the case, middle adults are still better at coping with intrusive thoughts than early adults, although it takes them longer at first to process an intrusive thought. Older adults tend to see the intrusive thought more as a cognitive failure rather than a moral failure in opposition to young adults. They have a harder time suppressing the intrusive thoughts than young adults causing them to experience higher stress levels when dealing with these thoughts.

Intrusive thoughts appear to occur at the same rate across the lifespan, however, older adults seem to be less negatively affected than younger adults. Older adults have more experience in ignoring or suppressing strong negative reactions to stress.

Associated conditions
Intrusive thoughts are associated with OCD or OCPD, but may also occur with other conditions such as post-traumatic stress disorder, clinical depression, postpartum depression, generalized anxiety disorder and anxiety.  One of these conditions is almost always present in people whose intrusive thoughts reach a clinical level of severity.  A large study published in 2005 found that aggressive, sexual, and religious obsessions were broadly associated with comorbid anxiety disorders and depression.  The intrusive thoughts that occur in a schizophrenic episode differ from the obsessional thoughts that occur with OCD or depression in that the intrusive thoughts of schizophrenics are false or delusional beliefs (i.e. held by the schizophrenic individual to be real and not doubted, as is typically the case with intrusive thoughts) .

Post-traumatic stress disorder
The key difference between OCD and post-traumatic stress disorder (PTSD) is that the intrusive thoughts of PTSD sufferers are of content relating to traumatic events that actually happened to them, whereas OCD sufferers have thoughts of imagined catastrophes.  PTSD patients with intrusive thoughts have to sort out violent, sexual, or blasphemous thoughts from memories of traumatic experiences.  When patients with intrusive thoughts do not respond to treatment, physicians may suspect past physical, emotional, or sexual abuse. If a person who has experienced trauma practices looks for the positive outcomes, it is suggested they will experience less depression and higher self well-being. While a person may experience less depression for benefit finding, they may also experience an increased amount of intrusive and/or avoidant thoughts.

One study looking at women with PTSD found that intrusive thoughts were more persistent when the individual tried to cope by using avoidance-based thought regulation strategies. Their findings further support that not all coping strategies are helpful in diminishing the frequency of intrusive thoughts.

Depression
People who are clinically depressed may experience intrusive thoughts more intensely, and view them as evidence that they are worthless or sinful people.  The suicidal thoughts that are common in depression must be distinguished from intrusive thoughts, because suicidal thoughts—unlike harmless sexual, aggressive, or religious thoughts—can be dangerous.

Non-depressed individuals have been shown to have a higher activation in the dorsolateral prefrontal cortex, which is the area of the brain that primarily functions in cognition, working memory, and planning, while attempting to suppress intrusive thoughts. This activation decreases in people at risk of or currently diagnosed with depression. When the intrusive thoughts re-emerge, non depressed individuals also  show higher activation levels in the anterior cingulate cortices, which functions in error detection, motivation, and emotional regulation, than their depressed counterparts.

Roughly 60% of depressed individuals report experiencing bodily, visual, or auditory perceptions along with their intrusive thoughts. There is a correlation with experiencing those sensations with intrusive thoughts and more intense depressive symptoms as well as the need for heavier treatment.

Postpartum depression and OCD
Unwanted thoughts by mothers about harming  infants are common in postpartum depression.  A 1999 study of 65 women with postpartum major depression by Katherine Wisner et al. found the most frequent aggressive thought for women with postpartum depression was causing harm to their newborn infants.  A study of 85 new parents found that 89% experienced intrusive images, for example, of the baby suffocating, having an accident, being harmed, or being kidnapped.

Some women may develop symptoms of OCD during pregnancy or the postpartum period. Postpartum OCD occurs mainly in women who may already have OCD, perhaps in a mild or undiagnosed form.  Postpartum depression and OCD may be comorbid (often occurring together). And though physicians may focus more on the depressive symptoms, one study found that obsessive thoughts did accompany postpartum depression in 57% of new mothers.

Wisner found common obsessions about harming babies in mothers experiencing postpartum depression include images of the baby lying dead in a casket or being eaten by sharks; stabbing the baby; throwing the baby down the stairs; or drowning or burning the baby (as by submerging it in the bathtub in the former case or throwing it in the fire or putting it in the microwave in the latter).  Baer estimates that up to 200,000 new mothers with postpartum depression each year may develop these obsessional thoughts about their babies; and because they may be reluctant to share these thoughts with a physician or family member, or suffer in silence out of fear they could be "crazy", their depression can worsen.

Intrusive fears of harming immediate children can last longer than the postpartum period.  A study of 100 clinically depressed women found that 41% had obsessive fears that they might harm their child, and some were afraid to care for their children.  Among non-depressed mothers, the study found 7% had thoughts of harming their child—a rate that yields an additional 280,000 non-depressed mothers in the United States with intrusive thoughts about harming their children.

Treatment
Treatment for intrusive thoughts is similar to treatment for OCD.  Exposure and response prevention therapy—also referred to as habituation or desensitization—is useful in treating intrusive thoughts.  Mild cases can also be treated with cognitive behavioral therapy, which helps patients identify and manage the unwanted thoughts.

Exposure therapy
Exposure therapy is the treatment of choice for intrusive thoughts. According to Deborah Osgood-Hynes, Psy.D. Director of Psychological Services and Training at the MGH/McLean OCD Institute, "In order to reduce a fear, you have to face a fear. This is true of all types of anxiety and fear reactions, not just OCD." Because it is uncomfortable to experience bad thoughts and urges, shame, doubt or fear, the initial reaction is usually to do something to make the feelings diminish.  By engaging in a ritual or compulsion to diminish the anxiety or bad feeling, the action is strengthened via a process called negative reinforcement—the mind learns that the way to avoid the bad feeling is by engaging in a ritual or compulsions.  When OCD becomes severe, this leads to more interference in life and continues the frequency and severity of the thoughts the person sought to avoid.

Exposure therapy (or exposure and response prevention) is the practice of staying in an anxiety-provoking or feared situation until the distress or anxiety diminishes.  The goal is to reduce the fear reaction, learning to not react to the bad thoughts.  This is the most effective way to reduce the frequency and severity of the intrusive thoughts.  The goal is to be able to "expose yourself to the thing that most triggers your fear or discomfort for one to two hours at a time, without leaving the situation, or doing anything else to distract or comfort you."  Exposure therapy will not eliminate intrusive thoughts—everyone has bad thoughts—but most patients find that it can decrease their thoughts sufficiently that intrusive thoughts no longer interfere with their lives.

Cognitive behavioral therapy
Cognitive behavioral therapy (CBT) is a newer therapy than exposure therapy, available for those unable or unwilling to undergo exposure therapy.  Cognitive therapy has been shown to be useful in reducing intrusive thoughts, but developing a conceptualization of the obsessions and compulsions with the patient is important. One of the strategies sometimes used in Cognitive Behavioral Theory is mindfulness exercises. These include practices such as being aware of the thoughts, accepting the thoughts without judgement for them, and “being larger than your thoughts.”

Medication
Antidepressants or antipsychotic medications may be used for more severe cases if intrusive thoughts do not respond to cognitive behavioral or exposure therapy alone.  Whether the cause of intrusive thoughts is OCD, depression, or post-traumatic stress disorder, the selective serotonin reuptake inhibitor (SSRI) drugs (a class of antidepressants) are the most commonly prescribed.  Intrusive thoughts may occur in persons with Tourette syndrome (TS) who also have OCD; the obsessions in TS-related OCD are thought to respond to SSRI drugs as well.

Antidepressants that have been shown to be effective in treating OCD include fluvoxamine (trade name Luvox), fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), citalopram (Celexa), and clomipramine (Anafranil).  Although SSRIs are known to be effective for OCD in general, there have been fewer studies on their effectiveness for intrusive thoughts.  A retrospective chart review of patients with sexual symptoms treated with SSRIs showed the greatest improvement was in those with intrusive sexual obsessions typical of OCD.  A study of ten patients with religious or blasphemous obsessions found that most patients responded to treatment with fluoxetine or clomipramine.  Women with postpartum depression often have anxiety as well, and may need lower starting doses of SSRIs; they may not respond fully to the medication, and may benefit from adding cognitive behavioral or response prevention therapy.

Patients with intense intrusive thoughts that do not respond to SSRIs or other antidepressants may be prescribed typical and atypical neuroleptics including risperidone (trade name Risperdal), ziprasidone (Geodon), haloperidol (Haldol), and pimozide (Orap).

Studies suggest that therapeutic doses of inositol may be useful in the treatment of obsessive thoughts.

Epidemiology
A 2007 study found that 78% of a clinical sample of OCD patients had intrusive images. Most people who suffer from intrusive thoughts have not identified themselves as having OCD, because they may not have what they believe to be classic symptoms of OCD, such as handwashing. Yet, epidemiological studies suggest that intrusive thoughts are the most common kind of OCD worldwide; if people in the United States with intrusive thoughts gathered, they would form the fourth-largest city in the US, following New York City, Los Angeles, and Chicago.

The prevalence of OCD in every culture studied is at least 2% of the population, and the majority of those have obsessions, or bad thoughts, only; this results in a conservative estimate of more than 2 million sufferers in the United States alone (as of 2000).  One author estimates that one in 50 adults have OCD and about 10–20% of these have sexual obsessions.  A recent study found that 25% of 293 patients with a primary diagnosis of OCD had a history of sexual obsessions.

See also

 
 Internal monologue
 The Imp of the Perverse
 Shoulder angel
 Tourette syndrome
 Earworm

Notes

References

Bibliography

Further reading

External links 

Symptoms and signs of mental disorders
Cognition Robert Jesse Stoller (December 15, 1924 – September 6, 1991), was an American Professor of Psychiatry at UCLA Medical School and a researcher at the UCLA Gender Identity Clinic. He was born in Crestwood, New York, and died in Los Angeles, California. He had psychoanalytic training at the Los Angeles Psychoanalytic Society and Institute from 1953 to 1961 with analysis by Hanna Fenichel.

He was the author of nine books, the co-author of three others, and the publisher of over 115 articles. 

Stoller is known for his theories concerning the development of gender identity and the dynamics of sexual excitement. In Sex and Gender (1968), Stoller articulates a challenge to Freud's belief in biological bisexuality. Drawing on his extensive research with transsexuals and new advances in the science of sex, Stoller advances his belief in "Primary Femininity," the initial orientation of both biological tissue and psychological identification toward feminine development. This early, non-conflictual phase contributes to a feminine core gender identity in both boys and girls unless a masculine force is present to interrupt the symbiotic relationship with the mother.

Stoller identifies three components in the formation of core gender identity, an innate and immutable sense of maleness or femaleness usually consolidated by the second year of life: 
Biological and hormonal influences;
Sex assignment at birth and 
Environmental and psychological influences with effects similar to imprinting.

Stoller asserts that threats to core gender identity are like threats to sense of self and result in the defenses known as the perversions. 

In his most notable contribution, Perversion (1975), Stoller attempts to illuminate the dynamics of sexual perversion and normalize it. Stoller suggests that perversion inevitably entails an expression of unconscious aggression in the form of revenge against a person who, in early years, made some form of threat to the child's core gender identity, either in the form of overt trauma or through the frustrations of the Oedipal conflict.

In Sexual Excitement (1979), Stoller finds the same perverse dynamics at work in all sexual excitement on a continuum from overt aggression to subtle fantasy. In focusing on the unconscious fantasy, and not the behavior, Stoller provides a way of analyzing the mental dynamics of sexuality, what he terms "erotics," while simultaneously de-emphasizing the pathology of any particular form of behavior. Stoller does not consider homosexuality as a monolithic behavior but rather as a range of sexual styles as diverse as heterosexuality. Many of Stoller's books, like Splitting (1973), are devoted to the documentation of the interviews on which he based his research.

Stoller died in a traffic accident near his home.

Selected publications
Stoller, Robert; Sex and Gender: On the Development of Masculinity and Femininity, Science House, New York City (1968) 383 p.
Stoller, Robert; Sex and Gender: the Transsexual Experiment, Hogarth Press, (1968) 328 p.
Stoller, Robert; Splitting: A Case of Female Masculinity, Quadrangle, New York, (1973) 395 p. 
Stoller, Robert; Perversion: The Erotic Form of Hatred, Pantheon, New York, (1975), 240 p.
Stoller, Robert; Sexual Excitement: Dynamics of Erotic Life, Pantheon, New York (1979), 281 p.
Stoller, Robert; Observing the Erotic Imagination, Yale University Press, New Haven, (1985), 228 p.
Stoller, Robert; Pain & Passion. A Psychoanalyst Explores the World of S & M, Plenum Press, New York, (1991), 306p.
Herdt, Gilbert, & Robert. J. Stoller, Intimate Communications: Erotics and the Study of Culture, New York, Columbia University Press (1990), 467 p.

References

American psychoanalysts
American ethnographers
American sexologists
Gender studies academics
David Geffen School of Medicine at UCLA faculty
1924 births
1991 deaths
University of California, San Francisco alumni
Transgender studies academics
Analysands of Hanna Fenichel